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I <br /> ` `° $ANoJOAQUIN Environmental Health Department <br /> !I�'=_ —COUNTY— <br /> ,�q Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 Inspector: i CP��t CONSTRUCTION <br /> Facility Address: <br /> Well Address: �Alv+V P_� Total Depth: <br /> WP# AAto1- Well#: ki W-�` Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company T W <br /> rl'f Screen Length From: To: <br /> Driller Onsite: r Filter Pack From: To: <br /> Consultant: Bentonite From: To: <br /> Geologist: 'S o�` <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes P-No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes PNo casing <br /> If yes,location and distance: height <br /> SAMPLING ABOVE-GROUND CHRsIY-BCx <br /> COMPLETION COMPLETION <br /> Holding Temperature: �nds,liCf � <br /> Method: <br /> Screening Method: grout <br /> rt. <br /> Verified Chain of Custody: ❑Yes ONO tt. <br /> — <br /> SPOILS <br /> C o <br /> Contamination Noted: El Yes ,2No <br /> If yes,spoils storage Location: .lotmd r <br /> saction <br /> Covered: ❑ Yes ONO — 9MV0 pack <br /> If yes,material: _ <br /> GROUTING or DESTRUCTION Total Depth: Io D <br /> Depth to Water: r0 ' <br /> Grout Material: %J4 t (DA MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ^-I 'qn w Casing Type: <br /> ❑Well Installation L�YJell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity 4remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons ea s allons ea s <br /> Thickest Thinnest #sags Thickest Thinnest #Bags 18entonlitelcenient Mix 3%Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per47lb 1.41 2.41 <br /> 5 in 2 10 20 2 Bentonite per 941b 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 —9 35 70 7 <br /> 20 40 1 ky 1 40 1 00 1 9 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s'cehd.com <br />